Trouble-free Snoozing

Although traditional insomnia treatments focus on helping people get to sleep, many insomniacs' worst problem is sleeping through the night. Cognitive behavioral therapy (CBT) may soothe the snooze problem: The Journal of the American Medical Association (2001, vol. 258, no. 14) recently reported that CBT helps insomniacs fall asleep—and stay that way.

According to the New York Institute for Cognitive and Behavior Therapy, CBT is a combination of cognitive therapy, which modifies patterns of thinking, and behavior therapy, which weakens the connection between situations and habitual reactions. For this study, CBT was tested against relaxation and placebo therapy in 75 people, ages 40 to 80, who usually awakened during the night for an hour or more. The CBT group was told to arise at the same time daily, get out of bed if they awakened and couldn't fall back asleep, eschew daytime napping, and use their bedroom exclusively for sleep. After every week that a participant slept 85 percent of his or her time in bed, bedtime was reset 15 minutes earlier. If sleep efficiency dropped below 80 percent, bedtime was reset 15 minutes later.

After six months, CBT participants had reduced their mid-night awake time to under 30 minutes, a 50 percent reduction. Sleep quality improved, while subjects' total sleep time increased to six hours nightly, which is considered to be minimally sufficient sleep. Relaxation- and placebo-therapy groups did not show comparable improvement.